Friday, November 3, 2006

Three National Heart Attack Registries Join Forces
By Richard Merritt, Duke University Medical Center News Office

Three of the largest registries that collect and analyze data about the care provided to patients who come to hospitals with chest pain or heart attack symptoms are combining to form a new and larger registry, a move that cardiologists at the Duke Clinical Research Institute said should improve patient care and save lives.

The Duke Clinical Research Institute will play a major role in the new registry, which will be called the National Cardiovascular Data Registry-Acute Coronary Treatment and Intervention Outcomes Network Registry. Announced by the participating registries on Thursday, Nov. 2, the new registry will officially begin operations in January 2007.

Among its efforts, the Duke Clinical Research Institute will coordinate the hospitals participating in the new registry, manage the collection and interpretation of data, and provide feedback to hospitals.

Eric Peterson, MD

"We felt that patients would be better served if we created a way for more collaboration and unity among all the hospitals across the United States that are participating in the various registries," said cardiologist Eric Peterson, M.D., who along with cardiologist Matthew Roe, M.D., will serve as Duke principal investigators for the new registry. "We believe this new partnership enhances our abilities to improve the quality of care for acute coronary syndrome patients."

Acute coronary syndrome is the general term describing patients who come to a hospital with symptoms of a heart attack and are found to have signs of heart muscle death based on blood or electrocardiogram tests.

Duke cardiologists were instrumental in the conception and implementation of one the three participating registries, known as CRUSADE. Started five years ago, this registry involves more than 500 hospitals in the United States and has collected clinical data on close to 200,000 patients.

The two other registries joining the collaboration are the National Registry of Myocardial Infarction, supported by Genentech, and the National Cardiovascular Data Registry, supported by American College of Cardiology Foundation.

Each of the three registries has collected detailed data on how patients with acute coronary syndrome were being treated in U.S. hospitals, with the goal helping hospitals stay current with the latest scientific findings.

Unlike clinical trials, which typically test a specific drug or treatment, registries are intended to gather information on how patients are being treated in the real world, from small community hospitals to large academic health centers. Registries collect information on diagnosis, any medications used or procedures performed, and how patients ultimately fared. With this kind of data, the Duke researchers said, it is possible to gauge the effectiveness of specific therapies and how individual hospitals are using them.

Matthew Roe, MD

"Analyses of these data can be a great tool for improving the quality of care at a hospital," Roe explained. "As we have been doing with CRUSADE, with the new registry we will be able to provide detailed feedback to individual hospitals on what they are doing right as well as identify areas for improvement."

For example, one of the goals of CRUSADE was to measure how participating hospitals were using medicines that have been proven effective in large clinical trials in treating acute coronary syndrome and preventing recurrent heart attacks. Over the registry's five-year history, the hospitals saw the use of these drugs increase from 68.1% to 83.2%.

"Improvements like this are remarkable, showing that it is possible to improve the quality of care for patients with acute coronary syndrome," Peterson said. "The new registry will use many of the features pioneered by CRUSADE, such as its web-based data collection system and tools for providing feedback to participating hospitals."

Since individual hospitals could be involved in more than one of the three registries, it made sense to standardize the data collection process, the researchers said. Over the past 10 years, more than 1,700 U.S. hospitals are estimated to have participated in at least one of the three registries.

"The new collaboration is good for science because it aligns the professional organizations and thought-leaders in quality improvement under a single umbrella," Roe said. "It is good for patients because we hope to reach many more hospitals this way and provide them with high-quality feedback. All this should lead to improvement in the care of patients with acute coronary syndromes."

CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC and AHA Guidelines) is supported by Schering-Plough Corp., with additional funding from Millennium Pharmaceuticals, a joint effort of Bristol-Meyers Squibb and Sanofi Pharmaceuticals.